Drexel University College of Medicine

Diseases and Conditions

Noma

Definition

Noma is a type of gangrene that destroys mucous membranes of the mouth and other tissues. It occurs in malnourished children in areas of poor cleanliness.

Alternative Names

Cancrum oris; Gangrenous stomatitis

Causes, incidence, and risk factors

The exact cause is unknown, but may be due to bacteria called fusospirochetal organisms.

This disorder most often occurs in young, severely malnourished children between the ages of 2 and 5. Often they have had an illness such as measles, scarlet fever, tuberculosis, cancer, or immunodeficiency.

Risk factors include Kwashiorkor and other forms of severe protein malnutrition, poor sanitation and poor cleanliness, disorders such as measles or leukemia, and living in an underdeveloped country.

Symptoms

Noma causes sudden, rapidly worsening tissue destruction. The gums and lining of the cheeks become inflamed and develop ulcers. The ulcers develop a foul-smelling drainage, causing breath odor and an odor to the skin.

The infection spreads to the skin, and the tissues in the lips and cheeks die. The process can eventually destroy the soft tissue and bone. Eventual destruction of the bones around the mouth cause deformity and loss of teeth

Noma can also affect the genitals, spreading to the genital skin (this is sometimes called noma pudendi).

Signs and tests

Physical examination shows inflamed areas of the mucous membranes, mouth ulcers, and skin ulcers. These ulcers have a foul-smelling drainage. There may be other signs of malnutrition.

Treatment

Antibiotics and proper nutrition helps stop the disease from getting worse. Plastic surgery may be necessary to remove destroyed tissues and reconstruct facial bones. This will improve facial appearance and the function of the mouth and jaw.

Expectations (prognosis)

In some cases, this condition can be deadly if left untreated. Other times, the condition may heal over time even without treatment. However, it can cause severe scarring and deformity.

Complications

• Disfigurement
• Discomfort

Calling your health care provider

Medical care is needed if mouth sores and inflammation occur and persist or worsen.

Prevention

Measures to improve nutrition, cleanliness, and sanitation may be helpful.

References

Chow AW. Infections of the oral cavity, neck, and head. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005:chap 57.

Physician Reference

International Classification of Diseases, 9^th Revision (ICD9)

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